Community hospitals across the country have been closing in recent years. Reasons given include system consolidations, rising costs of care, Medicare reimbursement issues, and changing models of health care delivery. Few hospital closures are welcomed by patients or employees, but those that take place in rural areas, where there may not be another hospital for many miles, often affect the local community with particular severity.

A double hit for local economies.

Not only do hospital closings in rural areas make access to health care a challenge, sometimes forcing local residents to drive many miles for care. But—as this month’s AJN Reports points out (“Will Rural Community Hospitals Survive?“)—rural hospital closings also have a ripple effect on a local economy, meaning lost jobs as well as lost revenue for ancillary businesses in the area.

Hospital that innovate may survive.

Despite current pressures, some rural hospitals are finding new ways to thrive. As the article describes in greater detail, hospital “survival strategies” include partnerships and “becoming increasingly creative with providing services,” including expanding the use of telehealth. […]

It’s estimated that Clostridium difficile (C. diff) causes about 450,000 infections and 15,000 deaths each year. Recently, on Facebook, AJN’s question of the week asked about isolation precautions for patients with C. diff. Most readers could not provide the correct answer to the multiple choice question.

Author and infection prevention nurse Nancy O’Connor explores the finer points of key basics, including the importance of maintaining a high index of suspicion for cases, performing excellent hand hygiene, and cleaning all surfaces in a case patient’s room with a bleach solution. (And did you know that if the patient remains in the same room posttreatment, after symptoms have resolved, the room should be terminally cleaned to avoid reinfection?)

Isolation precautions and C. diff.

So, what about isolation precautions, which need to be started as soon as C. diff is suspected? Most respondents to our Facebook question thought that standard precautions were sufficient until a C. diff diagnosis was confirmed. But if this “rule-out” patient with diarrhea is positive, does s/he begin to shed C. diff only after the infection has been diagnosed? Of course not. A […]

AJN received this guest post last week, when the effects of Hurricane Irma were still in the headlines, from Kathryn Jackman-Murphy, EdD, MSN, RN, professor of nursing at Naugatuck Valley Community College in Connecticut. The challenges she describes here are not specific to Hurricane Irma—they are faced again and again by those forced from their homes and communities by storms and other natural disasters, and they often happen out of sight of the media.

by patchy patch, via flickr

Right after Hurricane Irma began to hit Florida, I checked in with one of my son’s adult friends. He was searching for a safe landing site for himself and his elderly parents, as his initial plans to stay had been compromised by the hurricane. He was now in Tennessee, with no idea of where they would be able to stay until it was safe to return home. The dad is a Vietnam-era veteran with PTSD, hypertension, and diabetes. The mom also has diabetes and some limitations with mobility related to arthritis and walks with a cane.

How can nurses help?

Watching the devastation in Florida and Texas, I was searching for something to do to help. That’s what nurses do—we help. Being so far away in the Northeast, I felt not only helpless but acutely aware that my world was still intact while so many […]

On Sunday, September 10, many of the residents of coastal towns around the state of Florida sought shelter from Hurricane Irma in shelters, and in their homes when shelters reached capacity. Hurricane Harvey relief efforts were still fresh in the minds of the public—and in fact still underway—even as Florida prepared for a projected direct hit of Hurricane Irma and Georgia and South Carolina braced for storm surges and tropical storms.

By Tuesday, the weather system had dissipated and flood waters covered the areas hit by Hurricane Irma, creating environments that present many hazards, some known and others unknown. As other parts of the Southeast feel relief, with restored electricity and Internet and cell phone service restored, some towns that didn’t fare so well are still recovering from the devastation. Recovery may be hampered as we receive news of additional severe storms developing in the Atlantic.

For Florida residents in certain areas, the storm is far from over. Those most vulnerable for health problems in this post-hurricane period include persons with chronic conditions, children, older adults, those living in poverty and those newly impoverished by the hurricane, relief workers and first responders, undocumented immigrants, and the temporary […]

Suicide. A dear friend of mine died this way almost 40 years ago, leaving behind a beautiful six-month-old boy and a beloved and loving husband. I have never given any thought to the way we friends and family refer to her death. Then last week, I came across a 2015 blog post by the sister of a man who died in the same way.

In the post on a website that shares experiences of disability and mental illness, former hospice social worker Kyle Freeman argues that this term suggests criminality. She points to laws in the U.S. that, until a little more than 50 years ago, defined suicide as a criminal act. Kyle feels this history has perpetuated a sense of shame and embarrassment in survivors.

“…the residue of shame associated with the committal of a genuine crime remains attached to suicide. My brother did not commit a crime. He resorted to suicide, which he perceived, in his unwell mind, to be the only possible solution to his tremendous suffering.”

Kyle believes that the common use of the phrase “committed suicide” is not only inaccurate but can add to the suffering of those who have lost friends or family in this way. She prefers the term dying by suicide. […]